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MONDAY, July 29, 2013 (HealthDay
News) — A highly influential government panel of
experts is recommending that older smokers at high risk of lung
cancer receive annual low-dose CT scans to help detect and possibly
prevent the spread of the fatal disease.

The The U.S. Preventive Services Task Force (USPSTF) concluded that
the benefits to a very specific segment of smokers outweigh the risks involved
in receiving the annual scans, said co-vice chair Dr. Michael LeFevre, a
distinguished professor of family medicine at the University of
Missouri.

Specifically, the task force recommended annual low-dose CT scans for
current and former smokers aged 55 to 80 with at least a 30
"pack-year" history of smoking who have had a cigarette sometime
within the last 15 years. The person also should be generally healthy and a
good candidate for surgery should cancer be found, LeFevre said.

About 20,000 of the United States' nearly 160,000 annual lung cancer
deaths could be prevented if doctors follow these screening guidelines, LeFevre
said. Lung cancer found in its earliest stage is 80 percent curable, usually by
surgical removal of the tumor.

"That's a lot of people, and we feel it's worth it, but there
will still be a lot more people dying from lung cancer," he said.
"That's why the most important way to prevent lung cancer will continue to
be to convince smokers to quit."

Pack years are determined by multiplying the number of packs smoked
daily by the number of years a person has smoked. For example, a
person who has smoked two packs a day for 15 years has 30 pack years, as has a
person who has smoked a pack a day for 30 years.

The USPSTF issued its draft recommendation Monday after a thorough
review of previous research, and will take public comments on it until Aug. 26.
A report summary will be published online July 30 in the Annals of
Internal Medicine.

"I think they did a very good analysis of looking at the pros and
cons, the harms and benefits," said Dr. Albert Rizzo, immediate past chair
of the national board of directors of the American Lung Association. "They
looked at a balance of where we can get the best bang for our
buck."

The USPSTF is an independent volunteer panel of national health
experts who issue evidence-based recommendations on clinical services intended
to detect and prevent illness.

The task force has previously ruled on mammography, PSA testing and
other types of screening. It reports to the U.S. Congress every year and its
recommendations often serve as a basis for federal health care policy.
Insurance companies often follow USPSTF recommendations as well.

Weighing heavily in the task force's latest decision were the results
from the National Cancer Institute's 2011 National Lung Screening Trial. That
study, which involved more than 53,000 smokers across the United States, found
that annual low-dose CT screenings could prevent one of five lung cancer
deaths.

The guidelines revolve around who is at highest risk for lung cancer
and who would be able to benefit most from early detection.

Smoking is the biggest risk factor for lung cancer, and causes about
85 percent of lung cancers in the United States. The risk for developing lung
cancer increases with age, with most lung cancers occurring in people aged 55
and older.

However, the task force decided to limit CT screenings just to people
who either still smoke or quit smoking within the past 15 years. "If you
quit more than 15 years ago, because the risk of lung cancer goes down every
year from the time you quit smoking, we would take you out of that high-risk
category," LeFevre said.

The task force also had to weigh the benefits of early cancer
detection against the potential harm caused by regular exposure to radiation
from the CT scans, said recommendation co-author Dr. Linda Humphrey, a
professor of medicine and clinical epidemiology at Oregon Health &
Science University and associate chief of medicine at the Portland VA Medical
Center.

"The radiation associated with low-dose CT is on the order of the
radiation associated with mammography," Humphrey said. "It's not a
short-term risk, it's a long-term risk."

She added that there are a fair number of false positives involved in
CT scans for lung cancer. These can be resolved through screening, but that
adds to the number of radiation exposures a patient will receive.

The panel also had to weigh whether their recommendation would send
the message to smokers that they now don't have to quit because screening
measures will prevent their death from lung cancer.

"The main message of all this should be that you should stop
smoking," said former lung association board chair Rizzo, who is section
chief of pulmonary/critical care medicine at Christiana Care Health System in
Newark, Del.

"If you have started and you can't quit, there is an ability to
screen for that early lung cancer, but the screening does not mean we're going
to catch the cancer before it does you harm," Rizzo said. "This is
not an excuse for people to keep smoking, simply because they think they can
get screened adequately."

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